Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia

Abstract

Background:The incidence of multidrug-resistant (MDR) organisms is increasing along with mortality. Identifying risk factors for the development of MDR Gram-negative bacilli (GNB) bacteremia could greatly impact patient care and management. Methods: Data from the electronic health record of patients with GNB over 13-month period were collected at a single university medical center. Baseline demographic data, risk factor, microbiological data, recurrence of bacteremia, and mortality were recorded. Results: A total of 177 patients were included in the analysis. MDR GNB occurred in 46 patients (26%). The mortality rate in the MDR group was 34.8% compared to 13.7% in non-MDR group (p = 0.002). In multivariate analysis, diabetes mellitus [DM; odds ratio (OR): 2.8, 95% confidence interval (CI): 1-4.88], previous antibiotic use (OR: 2.93, 95% CI: 1.25-6.87), and urinary catheter as a source of infection (OR 5.96, 95% CI: 1.78-19.94) were significant risk factors for the development of MDR GNB. In addition, end-stage liver disease (OR: 3.64, 95% CI: 1.07-12.3), solid organ malignancy (OR: 3.64, 95% CI: 1.25-10.56), intra-abdominal source of infection (OR: 3.66, 95% CI: 1.14-11.73), inappropriate empiric antibiotics (OR 7.59, 95% CI: 1.68-34.34) and urinary catheter as a source of infection (OR 5.68, 95% CI: 1.37-23.5) were significant factors for mortality in patients with MDR GNB. Conclusion: Our study provides important information about the risk factors for the development of MDR GNB bacteremia and helps prognosticate patient with MDR GNB.

High Prevalence of Multidrug-Resistant Klebsiella pneumoniae Harboring Several Virulence and β-Lactamase Encoding Genes in a Brazilian Intensive Care Unit

“…In our study, the vast majority (84%, 21/25) of K. pneumoniae isolates showed MDR patterns including a high resistance rate to the common antibiotics used either alone or in association with one another to treat K. pneumoniae infections, such as β-lactams (including carbapenems), aminoglycosides, quinolones, glycylcycline, and polymyxin E. Although the high prevalence of MDR K. pneumoniae patterns was similar to other results in previous studies (Pereira et al, 2013; Paneru, 2015; Wasfi et al, 2016), this is the first report of a high incidence of MDR K. pneumoniae in the state of Tocantins, Brazil. There are many possible contributing factors to the emergence, rise, and spread of antibiotic resistance, including the new acquisition of resistance genes; transfer of antibiotic resistance genes; healthcare exposure; use of indwelling medical devices; limited diagnostic facilities; lack of effective and reliable surveillance systems; immunosuppressed states; travel to areas with a high endemicity of MDR bacteria; lack of new antimicrobial therapeutics; and inappropriate and excessive antibiotic use in health care, food-producing animals, and agriculture (Fletcher, 2015; Vila, 2015; Ayukekbong et al, 2017; Martin and Bachman, 2018; Patolia et al, 2018). Therefore, many of these risk factors may have contributed to the high rates of antibiotic resistance found in our study.…”

Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt

“…The development of multi-drug resistant K. pneumoniae (MDRKP) strains (resistance to three or more antimicrobial agent categories) leads to a growing global burden in choosing appropriate antibiotics in treating hospital-acquired infections (Davies and Davies, 2010). The emergence of MDRKP in healthcare facilities could be attributed to the acquisition of new resistance genes, use of invasive medical devices, inadequate diagnostic and surveillance systems, immunosuppressed states, and inappropriate use of antibiotics (Fletcher, 2015;Ayukekbong et al, 2017;Patolia et al, 2018). Unfortunately, the scenario of antimicrobial resistance has gotten worse in the recent few years, with the appearance of extensively drug-resistant (XDR, sensitive to at most two antimicrobial agent categories), and pan drug-resistant (PDR, resistance to all drugs) K. pneumoniae strains (Huang et al, 2018;Krapp et al, 2018).…”

Derivation and validation of a simple score to predict the presence of bacteria requiring carbapenem treatment in ICU-acquired bloodstream infection and pneumonia: CarbaSCORE

“…The cohort presented in our study was large given the topic studied. The most recent studies on this topic focused on smaller or similar patient cohorts [36–38]. For example, a recent study of risk factors for resistant GNB bloodstream infection in ICU used a cohort of 177 patients [36].…”